Simplifying pediatric emergencies | Peter Antevy (Founder & Chief Medical Officer at Handtevy)

Welcome to the Digital Thoughts podcast. My name is Zan Saeed and I am a pharmacist turned product manager. I have almost 10 years of clinical experience in oncology ranging from inpatient all the way to outpatient. My goal with this podcast is to bring people from all sides of the conversation together so that we can learn from each other and build a better healthcare system. In this podcast, we discuss everything digital health, from the people to the products. If you do enjoy what you listen to, please consider giving this podcast a five star rating in Apple Podcasts or Spotify. It really does help a lot. Thank you very much. And let's get into the episode. Today we have an awesome guest. Peter Entebbe is the founder and chief medical officer of Hand Tevy. In this episode we talk about why he started Hand Tevy, why pediatric codes are so difficult, the challenges of starting a business, and how Hentevi simplifies pediatric emergencies. This is a great episode. I hope you guys enjoyed as much as I did. Hey, Peter, how are you doing?

Zane, good to see you again. I'm glad to be on your show. Thanks so much.

Yeah, I'm really excited about this episode. But for those who don't know who you are, do you mind giving us a little background about yourself?

Sure. So my name is Peter Antevi. I am trained as a pediatric emergency medicine physician back in la, Children's of la. And then I went to the Children's of Pittsburgh where I became board certified in pediatric emergency medicine. And then in 2005 came back here to South Florida where I've been working at a level one trauma center and a freestanding children's hospital called Joe DiMaggio Children's Hospital.

Very cool, Very cool. And then you also have a company that you started. Do you want to talk a little bit about that as well and kind of how that came about? Because I think that's a really interesting story.

Sure. You know, back in 2005 when I first started my, my shifts here as a, as a real doctor, if you will, after six years of training at these great institutions and you know, everyone, when they saw me walk into the hospital like, oh, this, this guy, you know, smart guy, supposed to be the best guy here and there. And there's a lot of fanfare. And then I made a tenfold medication error which was something that thankfully the patient had a good outcome. But I gave ten times more epinephrine to a five year old girl, intramuscular epinephrine than she needed. And she was having anaphylactic reaction, her blood pressure was low. And I'll never forget, the nurse came to me with this.

Basically a long six foot piece of tape that's encased in wood, believe it or not. And she said, here's the dose. And I said, it looks good, give it. And the dose I pointed to was the tenfold overdose.

The monitor was alarming. Her blood pressure was through the roof now. Heart rate was really high. She's crying. Her hives went away, by the way. But she ended up having to stay the night in the pediatric intensive care unit. And I didn't realize at that moment, Zane, that it made an error. I only realized it afterwards. And in, in 2010, I became an EMS medical director, which means you're the, you're the physician for the fire department. And when, when I started getting involved heavily into ems, which is really what I do fully now, I'm a medical director for a number of fire departments and over 2,500 medics across four different counties, I started to see the same error that I made, plus many other errors. When you look at the literature on pediatric medication errors in EMS, it's a 50, 50 shot that you're going to get the medication right? Just think about that. And so when I made my medication error caused me a lot of stress. And then in the subsequent months, we had a kid come in. It was a one little kid, it was an infant. And he was, he was, it was a full code, meaning the kids in cardiac arrest. And the nurses started asking me all these dosages and so forth and then they pull out that long piece of wood board again and the parents are watching me. Literally, I'm standing in the code room and I'm holding up a six foot piece of plywood effectively. And I remember looking and looking at the parents looking at me in horror. The nurse is looking at me like this guy doesn't know what he's doing. And I knew at that moment that something was wrong. And when you look back though, since the 1980s, people were using this system.

And we were just told, you have to use this system. And I knew, I knew that I should not be using this system. And what's interesting, Zane, is that when I went to start making the change or thinking outside the box, everybody immediately called me crazy. And this is a standard of care and how dare you. And you shouldn't. It got to the point where even people in my own hospital were. When they saw me in the hallway, they wouldn't look me in the eyes, right? So one day in around 2008, I was sitting, it was a Sunday morning, and I reflected back upon my training in children of Pittsburgh. And one of my mentors name is Bob Hickey. Bob is like a legend in pediatric and resuscitation. He wrote the textbook. And I called up Bob and I said, bob, when I was in Pittsburgh, we never use this tape that they're giving me now that they've encased in wood. I said, you always used age. So instead of us measuring the kid when they got here, you just said, how old is the kid? Three. That means they should weigh 15 kilos. And I said. I said, why? Why am I here at this hospital doing something opposite of what you did? And you wrote. You wrote the textbook. And he says, pete, I have no idea. So even the people who wrote the textbook, who wrote the PALS guidelines, which is the standard American Heart association guidelines, were not doing what they wanted everybody else to do. And that was the moment, Zane, that I. It was that Sunday morning where I was streaming Bob, and I said, I'm gonna use age instead of length. And that was the morning I wrote on an 8 and a half by 5 inch piece of paper, 8 and a half by 11 piece of paper, 5 ages, 5 weights, and the 8 medications that I would need during the resuscitation. And it almost jumped off the paper. A pattern that I committed to memory. And in every subsequent code, if someone just gave me an age, I can rattle off the eight medications that we potentially could need. And if you would just have seen the eyes of the nurses, that next code, they looked at me like, this guy's come alive.

And I kept this little secret to myself because I was so embarrassed for two years. And Marikar was a nurse I work with. She says, pete, you're doing something. You got to tell me what it is, and you got to teach other people what you did. So she said, you're giving a lecture next week, and you go teach the people your little trick. So I had this big lecture done on pediatric drowning, and I added two slides at the very end of this little trick. And at the end of the talk, there's 200 people in the audience. 50 people walk up to me, and I'm like, oh, wow, was it talk that good? And they're like, no, we want those last two slides. And in that line were anesthesiologists, paramedics, nurses. And that was the day I came up to my wife and I said, it's not just me.

And so we ended up. She said, why don't you create a badge, buddy. So I created a little piece of plastic that goes on the badge at the hospital. And I come to the hospital with like 10 of them, 20 of them gone. I brought 50 of them gone. I brought boxes of them gone. I started getting asked to do lectures around the country. I would bring boxes of these things hundreds at a time, gone. And I'm thinking to myself, this is incredible. And for years I just. We just did that. I just, I was just giving talks for free. I'd fly anywhere, people would ask me to come. And then I started to understand that a change has to happen. And that's when I went on this journey that I'm still on today. We started in 2010 formally, and we're now 13 years. 13 and a half years in.

Yeah. That's amazing. Thank you for sharing that. Because I think that a lot of people sometimes forget that we're humans as well. Right. Even though we're the ones kind of the last line of defense. I mean, I've gone to codes. Uh, I've been. I've stand. I've stood in the corner, petrified, hoping that somebody doesn't look at me and ask me for a dose. I've been in there. I've been in pals, codes and that. So for the. For people that don't know what he's talking about, it's a tape that goes by height and it. And it. Where the. Where how tall the kid is, is what dictates the dose. Right? That's kind of what you're talking about. It's called Broslow tape. I think it's referred to.

And by the way, we need to mention it, Dr. Jim Broslow was a legend, right? What he created and put out in 1985, 1986, time frame was legendary, and it was life saving. Okay? And so for everyone to understand that that that was a tape that, just like you had mentioned, provides a dosing that there's two main differences. Number one is that it's only height, which means that you can only use it once you're in front of the child. Whereas age you can use as soon as you hear the age. But the second, maybe the more important one is that it's not customized. It's not customized to the EMS organization, it's not customized to the cruise ship, it's not customized to the hospital. And what we've done is there's a lot of work that happens before an agency goes live, but we actually take the time to customize every dose to every drug to every concentration, to every route, and then the magic happens. And that's. Those are two big differences.

Yeah. And. And the key. And I think the reason why people were so excited about those last two slides and all those badge buddies you were creating is because when you're in that situation, when you're in a crisis situation, literally life or death, the last thing you want to be doing is reacting. I mean, the last thing you want to be doing is thinking you need to be reacting. Right. You don't want to be calculating stuff you need. You don't want to be like, it should just be. Literally, the algorithm is just running through your head. You should be four or five steps ahead. But if you're so worried about calculating and, And PALS codes, if you're not, PALS codes are, generally speaking, it's for children. But if whenever a PALS code comes in and you're not a children's hospital, everyone is petrified, Even the most seasoned ER doctors are, because we're not used to it, right? So, like, that's why I think. I mean, that's why these things are so amazing, is when you can refer to something and you know it works, and it. Then you can kind of just do what you're trained to do, and you just kind of fall into your training. Kind of like, we didn't know. You said you kind of came alive. Right. Because you're, You're. You're allowing yourself to kind of go back to what you were trained to do.

Right. And I think for people listening to this, I mean, everything you said is very important, because if you're listening to this somewhere in New York City or in Palo Alto or. Or somewhere, and you call 91 1, it turns out that if you haven't been trained the right way or if you're still using an old system, what. What ends up happening is the paramedics get to the house, they see a little kid, and they see freaked out parents. They grab the kid and they just run to their ambulance and they go lights and sirens to the hospital. And the parents think, all along my kids getting the treatment. No, they're not. They end up just driving to the hospital. And I know that because I received, over the last 23 years, so many patients just didn't get correct treatment. So now we're trying to reverse that. And we really made very deep inroads into EMS so that communities all around the country can be sure that when their child, God forbid, is having a seizure or their child drowned in a pool or the Child fell out of the tree, severe head injury, needs to be intubated, needs medication for pain, that they actually don't die because of a medication error, and that there's no error of omission, meaning that instead of giving a drug, I'm making a mistake, I'll just not give the drug. That's an error of omission, which is just as bad as, you know, in the pharmacy world, if you don't give a drug to a kid who's seizing, the morbidity related to that, prolonged seizures is significant. And I think that's what we're trying to solve here across this country.

Yeah. 100. I mean, there's. I mean, we've had patients come in, you know, there's a certain time, you know, like, the earlier you can treat the person, the better off you are. Right? Because even. Even if you can come back from that event, there's. There's potentially lifelong ailments that can occur, you know, based on if your brain loses oxygen for a certain amount of time or, you know, so on and so forth. So 100% agree. And then, you know, like. Like you said, like the tools that. The tool that you created and other. I mean, the whole point of creating these tools or algorithms and all these things and having them on paper and or around where it's easy is so we don't run into situations like that, even if you don't know. And I think that's one thing in medicine that people don't realize, outside of the people that actually practice medicine, is a lot of times we don't know the answer.

Right.

But we just know where to look, and we know where to look quickly and find it quickly. And that's really what differentiates us. And also, we know how to take the data in and understand it.

Right.

I mean, there's a lot more to that, but, I mean, there is something to that, right? Being able to find it in the right place.

Well, it's fascinating. This is I, you know, this is the kind of thing that I love to talk about because there's a one book that changed my life, and it's called Thinking Fast and Slow by Daniel Kahneman. And he talks about these types of situations where, you know, listen, I love being in resuscitations. I love being the head of the resuscitation. There's one thing I can't do, and like you mentioned, is I can't do math or someone's dying in front of me. And Kahneman talks about system one versus system two, thinking Doing math of any kind is system two thinking. Being a pediatric ER doc running the code. If a child is dying when the parents are looking at you, you need system one thinking. It's that automatic thinking that you were talking about. Once I recognize that all of pediatric dosing is system two, and we can just remove that from the equation, take the cognitive offload completely away. We offload the cognitive aspect, and now you can sit there in the code in a system one manner. My heart rate, it still goes up. It just doesn't go up that much. My hands don't sweat. I can look at the mom and dad. I can bring them over to me during the code, during the resuscitation, I bring the parents right next to me. Why? Because I can. Why? Because I don't have that system two shadow or cloud above me, not allowing me to think straight and do the right thing. So that's what we try to do. And understanding that one little thing is probably one of the most important things that happened in my life to help me along this journey is figuring out how the brain thinks during these particular situations.

Yeah. No, that's amazing. I'd have to look into that book. But it's so true. I mean, I think what you said is perfect. Like, you know, try to do math, you know, in a dire situation. I remember one time, it was a. It was literally going down by 10, right? You know, it was a factor of 10. And I'm sitting there with a syringe and a vial in my hand. Uh, I think it was lorazepam or something. I can't remember exactly. And somebody's like, I need this. This many ccs. And I'm sitting there, okay, the dose is this. And it's a 2 ML vial. And I'm, like, sitting there. I'm like, how many mls do I need? It's just like. And I'm, like, sitting there for, like, five, like, couple. It seemed like five minutes, probably like 30 seconds. And I have, like, a paper and pencil out. Literally. Any other time I would have been like, yep, this is it. But at that time, it was just like. I couldn't think. It was just like, okay, I. Because you're like, okay, am I grabbing the right drug? Am I grabbing the right syringe? Am I grabbing the right things? Like, and then on top of that, I have to figure out, okay, this is. This is how much I need to pull out, right? It's. It's. It's really. It's. It's. It's an Experience that I hope nobody really goes through. But you don't really understand it until you go through that experience.

Well, it's funny, I'm kind of like going back and through the memory bank here. But you know, I've been in hundreds of codes, right? And I would call out for three drugs, right, for rsi. And then I'm looking at the medication nurse who's right there and they do exactly what you just described. This is before we had. They had the system to use, they had the syringes and they pulled them up and then they're going back and they're doing it again and they're getting on a calculator. And I said, can we please have those medications given to the child? And they said, I need another minute or two. They would bring over another nurse, double check me. I'm like, okay, the child's not breathing, I have to put it, I have to put a tube in there in their trachea. But it's what we learned is, is that the most stressful role in the code. You know, you have a, you know, you have the person running the code, the physician, you have documentation nurse or procedure nurse. But then you have the medication nurse, it turns out that is. Or the pharmacist, if you're lucky enough that someone like you in the code. But it turns out that is the most stressful role in the room. And not many people recognize what you just said. So I'm glad you said it.

Well, thank you. Yeah, I mean being in that role is, I mean, and really the only thing that I used to combat with that with eventually you get to enough, but just knowing what the next step is, knowing like, hey, they're going to call for this, this and this, getting those out, knowing the calculation. Or in my case I would write down like common doses and mls. So I didn't have to think at that time, it's like, okay, he asked for this many CCs. Okay, this is to this many milligrams. Cuz that's the other thing, right? If you train yourself like, okay, I'm looking for milligram dosing or microgram, whatever dosing, then you have to convert to mls. Oh, they give you an mls. Now you gotta convert it into milligrams. And just having all that written down. And so like you said, like it's just system one thinking. I'm just thinking like, okay, this is what I need. I don't have to worry about. It's already, I've already done the calculation when I was Much more, less stressed out at home or, you know, and at my terminal or whatever.

Right. But it's interesting because what, what people don't recognize is that we're probably stressing a lot of people out here, but when you're, when you're a, let's say a four month old who needs a fentanyl drip, you're probably going to have that at a different concentration than the in year old, which is. So you have to, you have to mix that drip differently. Right. And just for everyone's concepts and they understand, there's about 40 or so medications that you would kind of have in your, in your toolbox, if you will, during the resuscitation. Some of them are easy, you just drop and push. Some of you have to dilute, some you have to put and you have to infuse in over a period of time. And some you cannot push fast. If not, you'll cause things like laryngospasm, etc. And so the math is one thing, but then having to figure out how to mix this thing and what concentration to mix it at and then how do I set up the pump, etc. All those things pile up and all of a sudden you're, instead of dealing with a child and looking at the parents and helping them through everything, you're now lost in system two thinking. And people cry after codes. They quit after codes in ems. They, they weren't even talking to the family member because they were so, you know, there was such a lack of confidence of what they just did. And the parents were waiting to hear that information from the, the lieutenant or the captain and then just take stage, stage right. And they leave. And the parent says, I wonder why they didn't talk to me. Maybe they didn't do the best thing for my child. And it's just vicious cycle of badness. That all starts with medication dosing for children. And it has led for people to quit their jobs, commit suicide. The ramifications of what happens, that the late public doesn't recognize what happens in the back of ambulances. They don't recognize what happens in a trauma bay, in a code room. That is not just bad for the child and the family, but is also bad for the healthcare personnel treating those folks 100%.

And, and, and yeah, like I said, I've been, I've been in pretty bad one bad codes like hours long. Sometimes in some cases people made, some make it, some don't. You know, you've, and then you, you know, and then the other thing is like, while you're, While you're going through it, you can't put yourself in. You can't connect yourself too much. Right? Because then that's another thing. Like, it'll stop you from doing your job properly. But then after the fact, you know, the families around you or whatever, and then it all comes rushing in. And, you know, you. There's this. There's this thing where, I mean, maybe you, Maybe you're different, but you can't feel the same thing. Even though you're sad or upset or whatever, you know, it's somebody else's child, it's somebody else's father, whatever. Like, you have to be strong for them. And that in itself takes some toll because now you're pushing all those emotions down again, and it's just like. And all this stuff just keeps piling up and piling up. And if you made a mistake, kind of like what you mentioned, like, you made a mistake one time, now you're hypervigilant about that thing, but then you forget about something else, and it's just like this constant vicious cycle. And that's why I like tools like yours. And that's why I was excited to talk to you, was because when you were. When we talked earlier and you told me what you guys were building, I'm like, this is amazing, because for someone like me who's gone through it, gone through the cycle, you know, fortunately, you know, didn't have anything bad happen or anything like that, but there were many times where it could have gone pretty bad. Right. I was just really lucky. I had a good team around me. People were always running over to help me out. But, you know, sometimes that doesn't happen. Sometimes you're in a rural hospital by yourself and you just have you and the other person around you. And that's where, like, you know, tools like, like Hentevi and stuff are like, literally priceless.

I, I appreciate that. I want to go back to the, to the part that you mentioned that was important, which is empathy. Right. You know, if you're in this business, like, you are, like I am, we're empathetic people. You should not be in healthcare if the people that you're treating that you don't feel for them, because if you don't feel for them, then you're not going to help them through their difficult situation. And in, in, in the work that we do, no one's ever happy to come see us. Yeah, they're there at their worst day. You're telling them a diagnosis of brain cancer. Diabetes, appendicitis. You know, your child is, is brain dead. Your child is dead. Right. It's very, very difficult, however, and I guess we'll talk about this in a minute, but, you know, now this conversion into this world of the business world. Right. I'm, I'm no good at that. And it turns out that, and I saw a Twitter thread recently talking about, you know, how come, how come doctors don't run businesses? A lot of them don't. And it's because, you know, this is the way my feeling is, is that if you're in the caring for people business, then you're probably not going to be so good at business. Now, there are people who are, who are, who are unicorns, in my opinion. But I think you have to feel for the patient. I think you have to care for people. And in my particular case, it makes me not a good business person. And I'm very fortunate that my wife is just an incredible business person. She's an incredible human being. And so all the skills that she has, I don't have, and the skills that I have, she doesn't have the medical aspects of that. But we make a good team. But I'm happily, and I hopefully will always stay in the empathy lane of what we do, because I do think that when you're dealing with life and death, and unfortunately, today in this country, 90% of the kids who go into cardiac arrest die or end up in a vegetative state. So there's 20,000 children every year in this country who go into cardiac arrest, 19,000 of which end up either dead or a vegetative state. Just, just think of those numbers. And that's why I'm never going to stop doing what I'm doing until, until we kind of make a dent in those numbers.

Yeah, no, that's, that's pretty staggering numbers. And I agree with you. And I mean, what you said there is kind of. Exactly. I mean, we kind of touch on, like, your, your journey in the business world because I think it's, it's important to talk about, especially because, you know, there's a lot of medical people trying to get into the world and sometimes they get, sometimes they don't like it and they go back. Right. And I think that we lose a lot of good people that way. And, you know, and maybe people can learn from your, your journey a little bit. But, I mean, you know, two important points that you brought up was a, you know, you have a mission and a vision that you're driving towards. Right. It's it's what's keeping you. So like when things aren't going right, you are being driven by what you've seen and what you're doing. And then the other thing is, you know, your co founder, your, your co person is your wife, happens to be your wife. But it's a perfect person because they compliment you perfectly. Right. They're not everything that you are. Right. If you were to ER docs, it wouldn't be the same, right, because you guys are both doing the same things. So that's another important thing I think a lot of people need to understand or learn is you need to go out of your circle when you're, when you're going around these things, sometimes you're lucky enough to have married to. Married to that person, or sometimes you have to kind of go out on a limb and talk to other people and, and try to find that the best fit for you.

You know what? I think that's huge advice. And now looking back at my journey and I see every day what Allison does and how, how she organizes, how she thinks, how she strategizes, how she executes, how she builds a team, how she follows up with people.

You know, I'm, I'm the vision guy, right? I'm the medical guy. And I can see, you know, where we need to be even in five years ahead. I have no idea how to get there. If it was just me zing with my idea, I would still be working in the emergency department with my little bad buddy, right? That, that, that, that would honestly be where we were. We would be today. So there are really smart people out there. And, you know, now I'm not in the, I'm in a circle of other kind of physician entrepreneurs and I'm watching them go through it and helping to coach them a little bit. And guess what? None of them are the CEO of their companies. They have found people to be the CEO of their companies because they quickly realized that they don't have the skill set of an entrepreneur. You know, I happen to have two older brothers who founded a software company in construction industry many years ago and they recently exited. But my older brother, who's the business guy is like my wife. He's brilliant. But when he, when he talks and when he talks about business, I have, I like, it's kind of boring and I don't really like it and it's stressful to be quite honest to me.

So, yeah, I agree. I think that the same with me. Like, I mean, I like, I like vision strategy all that stuff I can be in a room, locked in, talk to people about, you know, product, market, fit, all these things. Love that. When it comes to like ROI calculations and these kind of things, I'm like, even, like, even when I had my startup, my co founder wasn't in medicine. He was just straight business. You know, I just took care of the product part of it and he took care of the business part and it was amazing. So you say that you are kind of in the circle. So what advice would you give to people? How do they find this person? How do they find their opposite?

That's a, you know, that's a great question.

I mean, I wouldn't know the answer to that except that, I mean, I know that there's a lot of people out there and if you, if you're in the circles when you're going to these conferences, probably that's where I would start nowadays. But there used to be years ago there were hackathons and people would go, you know, the, the doctor would meet the engineer and the engineer would then have a friend and so forth. But what I recommend to people, because I got a lot of people who call me and they say I have an idea. And so I, I listen, I always take the phone call, I always listen to people. And what I tell people is that, you know, you're not going to go look for a CEO on day one before you've done anything. So I kind of have the Jeff Bezos thought process, which is what he tells people to do is make the website, go put up a website as if what you're going to do is built 100% product market or forget the product market fit. Just that here's my product, this is what I'm going to do. And then sign up for my waiting list, right? Products not ready yet. Start making phone calls to the people who are going to buy your product and say, hey, you know what, I'm building this thing. You're the expert, Zane and I wanted to pick your brain, right? Even though you're really the customer. And I tell them if halfway through the conversation they start asking you like, hey, how much is this going to cost? Or when is it going to be ready? I said now you know that you're probably on the right track. But I think nowadays people are too quick to go look for money, venture capital.

And they don't do enough of the just go work and do it without having to go raise millions of dollars. And there's no code platforms. There's a lot of ways you can do this today to at least prove that you're going to do it, that it's going to work, number one. But in health tech and health care, it is hard to actually even get in. So you could have the perfect solution for an ehr, right? And the EPIC people may just say, you go screw yourself. Judy Faulkner is not going to let you in the door, right, because.

It'S a very competitive world. And then the hospital, there is layers and layers and layers of red tape. You have to have like four or five threads of people who have to know about your product at the same time. All these different meetings. Then legal comes in and the sales cycle is like a year long or more. So here you are, let's say you've gotten funded and your VCs are waiting for something to happen and you have a sales cycle that takes a year.

Those companies are destined to fail, right, because they haven't evaluated the market well enough. They don't recognize that it's a 10 year journey at least to get in and have a hold of the market that you're trying to get into. People end up doing free pilots and all the other stuff and then they end up getting kicked out the door because there's a lot of turnover at these hospitals and they don't have the budget, etc. So this is a very, very difficult space. And it takes someone who does have a mission. And you know that you're going to wake up every morning. And you know, I had to, I had to keep telling myself that they're wrong. And I knew that they were wrong. They still don't think that they're wrong, by the way. But that, that's what kept me going, is that it's what I did for a living. You know, I was the guy who everyone's eyeballs were on and I couldn't use this system. And so I knew that if I figured it out.

It would work. But what I didn't realize is that it took me six or seven years for people to even talk to me and actually say we're going to listen to you. Even though today we're like the darling of the industry and everybody wants to talk to us. How come you wouldn't talk to me for the six or seven years is because in healthcare, what people don't recognize is that they've been doing it that way for many, many, many years. And you, little peon, Peter Antebbie are not going to come to me and tell me that you know better because I never heard of you before, so you can get out of my office and I'm never going to talk to you again. And that's what, that's what happens. And, you know, if you talk to any founder in health tech today, they, they get, they get on for, for years, until one day they've done enough hard work and they've gotten the early adopters, the next early adopter, which is what we did. We went one at a time at a time at a time, and now we look back and we're in over 2,000 cities in all 50 states, and our app is maybe going to treat a million patients this year alone. And I look back and I say to myself, that was the hardest thing I've ever done, but it's the most rewarding thing because of the phone calls, the emails every week we get. I just was on the phone call before I came on with you, of another child who was saved yesterday in Chesapeake, Virginia.

And so that, that's what keeps me going, you know, so anyway, sorry.

No, no. And I think that, I mean, you can see the passion and that's what, that's what you need. You need to keep that going. And I, and, you know, it's great to see that, because this matters. This is not something that you, this is not a side gig for you. This is not something that you were just like, oh, whatever. This, this is our career, this is our life. And I think people don't understand that when, when you, when.

It'S really hard to step out of your comfort zone, like you said, especially in the medical community, it's very. As much as I love the medical. We both love the medical community, we are part of the medical community. But it's very sometimes get off my lawn type situation. Like, hey, this is, you know, nothing new can come through. Even though it's better, even though studies are showing that it is, it's just not gonna happen. And, you know, and then, like, to your point, you know, it took you six to seven years. This wasn't an overnight thing. Right. And I think that's another thing that I. We need to tell people is everyone just sees the glitz and glamour. They don't see the hard work that goes in. All the emails, all the traveling, all this getting yelled at, being told you're stupid, that you're never gonna.

Right.

I mean, those are conversations that happen all the time that we don't, we don't talk about. But it's just like, like you said, like, you know, you can see your passion is what is getting you through. And that's why I tell people, if you're passionate about something, then do it. If you're just kind of dipping your toe into it, don't. It's not worth it. It's really not. Because your, your sanity is worth more than the possible payout in the end.

Well, listen, you know, I, I listen to what you just said, and I can tell you that there were many years, you know, that my wife has, you know, a huge, you know, she has a huge ability. You know, she, she worked in the government. You know, she worked, she worked at very high levels. And when we, when we first started on this journey, she wanted nothing to do with it because why? It was just. She and I, and I had this crazy idea and it was tough. I mean, I can tell you that there were, there were days where she was like, why are you doing this to me? Why are you dragging me into this? No one's listening to you. And I remember I would, I would wake up in the middle of the night, and I sleep very well, by the way, but I would wake up in the middle of the night and I, and I would. And she's like, what's going on? And I said, we, we have to do this. And I had just had another idea pop into my head and, and then we started, we started hiring our first employee, then another employee, and then it came to, you know, now we had a little, we have, we had a little bit, little office, and then we had to pay, you know, salaries. And there was a couple months where my wife came to me and she says, you know, we don't have enough money to pay the staff, you know, coming up in two weeks from now. And I said, what are we gonna do? I have no idea. Right? So she brings in the bankers, we get a line of credit. I'll never forget, it was very short lady who walked into my office with these two kind of bigger guys, almost like bodyguards, whatever, and it was just a four hundred thousand dollar line of credit, like, you know, just so we can pay and so forth. And she, she, she pushed the papers over to the other side of the table in our conference room and she says, you know, Dr. And Tevi, I think you're making the right decision, but just, I, I just need you to know that by you signing this piece of paper, you're, you're, we're putting a lien on your house if you, if, if the money doesn't get paid back. I said, so, so wait a minute, you're telling me that if the Business goes down, you get my house. And she smiled at me and she said yes. And like, oh, my God, like, you know. And so we ended up dipping into the line of credit to the tune of hundreds of thousands of dollars, you know, and you, you choke up every time you think about it. And, and finally we, we, you know, we had that dip like all companies do until you kind of get true product market fit. That took years.

And that line of credit has been. We haven't touched it in years, right? Maybe two or three years now. And. But I think of those days and I think of how difficult it really is and the stress that you put upon yourself. And if you don't have that confidence, if you don't have that drive to wake up every morning and you're going to solve this problem, you quit, right? Or you get divorced or something bad happens. And so I think that unless you have that thing, like I have a buddy of mine who created a device called the Life Flow. It enables you to get a bag of a unit of blood and a child or adult in within three to four minutes.

You know, he had a patient who, he couldn't get fluid and fast enough and, you know, the kids dying in front of him. So he wakes up every morning and he makes sure that he's going to make this company work and he's doing an amazing job. But that's the kind of stakes we're talking about here. You have to be. It can't just be that I want to, I want to be on the COVID of the Ink magazine or whatever the vanity metric of the day is. Can it can't be that.

Yeah, 100%. And I think that, and this is not to discourage people at all. This is just to just. This is just. I think this, this part of, this part of the life is not talked about enough. And I think that it's a disservice to all the people that think that are told like, hey, your idea is great. You're doing this. It's is going to, you're going to, you're going to succeed. I mean.

Sometimes we don't succeed, right? Like, majority of businesses fail. And I think it's really, really, really, it's a disservice to those people because if they just knew a little bit in the, in the front end, they can kind of prepare themselves, understand that it's going to be hard. There might be these steps we need to look into and they might have succeeded, right, if they kind of knew the big picture. And that's One thing that I, I try to tell people and, like, when somebody comes to me with an idea like yourself, I always listen to people's ideas, but I also try not to sugarcoat things. I mean, there's a fine line between telling them they're telling them their idea is not going to work, and then also being encouraging enough to be like, hey, think about it this way, right? Like, I mean, you don't. Because in the, in the end, it's somebody else's life, somebody else's idea, somebody else's passion, right? If, if I am passionate about something, I've been told I'm crazy. I've been told this. So, like, I have to remember that when I'm talking to people like, hey, I'm talking about this person's passion. This might be their life's goal.

Yes.

And I have to be very careful as to how to talk about it. But I also can't tell them that what they're doing is right because, again, it's their passion, and I don't want them to end up on the street or lose their house or, you know, God forbid, lose something else.

Well, listen, I agree with you 100%. And, you know, I always tell people that if everyone loves your idea, it's probably not a good idea because it's already been done before. You have to have a bit of crazy in the idea. But I think that what you're saying is that, you know, you have to reverse some of the steps, right? So instead of what a lot of people do is they build the product, they spend all this money, they, whatever, they hire engineers, and they haven't talked to one person, one customer, a potential customer. And then they have something, and then they say, okay, now we're going to go to market. And that's the moment they realize that they spent, you know, 200 grand and, and nobody wants what they built. So I just think that if you, you guide that in the reverse, then I think that's the way to do it.

100. I mean, like, even. Let's take your example first. For instance, you know, you, you're talking about those badge buddies, but that's part of product market fit you. Everywhere you went, they were gone. Right. It's not like you came back with all of them. Right. But everywhere you were going, they were going. So it was like, hey, people are really interested in this. Yeah, there's a big step between free and paid. Yes, we're, we're acknowledging that, but that was, that was you. You know, customers are reaching out to you, you know, those. Those people, after the interview, you're being flown out to talk about this. So there is something to that. I think a lot of people skip that part. And it's a. And it's honestly probably the worst. Some of the worst part. Right. Because it's boring. You. You're like, not. You're building, but not really building. You're just kind of feeling it out. And your idea, you're already like 10 years ahead, but you're. You're being forced to pull yourself back. But that is the most important part about building something is that initial grind and getting. Getting to it. And you're gonna not make money. The first that during that time, you just have to be okay with it, but at least have a plan to kind of keep yourself afloat.

Yes. Right. And then, you know, to that point, you know, I was recognizing emergency medicine physician doing at that time, you know, 16 to 18 shifts a month. Then I became a medical director for some fire departments, and I was able to kind of buy down some of my shifts, if you will, give me a little bit of time to work on the company and. Because, you know, for years, you know, we weren't making any money. And then. And then finally now I've. I've really rolled back my. My emergency medicine shifts completely. And now medical director for these fire departments, which is, you know, the best job in the world. And obviously work half of my time now with the company and putting out education and traveling and speaking, etc, but there's no way that I could have sustained the company without having another job, without. Without getting any. Any kind of funding or venture money, which we never did. So the only way that we could do it is to continue to work while building the company. And so I can imagine all the people listening out here today are, unless they're independently wealthy, you have to pay the mortgage. You got to pay. You got to pay your bills, you got to feed your kids. And if you have this idea that needs funding as well, that's where you have to kind of determine, how am I going to do this? And that's why I say don't build right away. Do a lot of the prep work to see if it's even worthwhile going to friends and family or taking a loan or I think as a last resort, going and getting venture money from people.

Yeah. And funny. And not to say funny, but the interesting part is that's kind of how we practice medicine. Right. Like, before a protocol gets rolled out, we're like, researching it, making sure it's right, we're making sure that people are buying into it and then we kind of roll it out over time slowly to like a specific department or specific physician or. And then kind of hospital wide and then, then the rest of your hospital and it's kind of. And that's why I said tell people like honestly as, as medical people, we are trained to be business people, but we don't really realize it.

Right.

I'm not talking about the money part of it, but like the actual step by step process because medicine is the same. It's just, just change medicine with business, the process to getting something going is almost exactly the same.

Well, and I, I agree with you. So I'll give you a perfect example. You know, I was, I was a medical director at Parkland, right. Marjorie Stoneman Douglas shooting. And you know, unfortunately 17amazing people died that day. Right. But we didn't have on the scene that day was blood right, left, preserved for the trauma center. Well, in, in San Antonio they said no, we're going to start carrying blood on, on, on the ambulances. Great. So they did it and it's been successful. So now I wanted to do the same thing. So you know, going through the process of convincing the fire chief and talking to the city commissioners and getting buy in and doing the work and getting, doing the research and then ramping up, that took us a couple years. But now today we have blood on the streets in Palm Beach County, Florida, in the whole county, Broward County, Florida. And we're one of the less than 100 agencies in this country who are doing it. But it's the same thing is that you have to be able to lead people, do things that people had never done before. Now the good thing about being a medical director is that there's no business part of that for me it's just the leadership part of it. Somebody else pays for that stuff. Right. So I kind of find myself in these situations where, you know, I can see the idea, I know how to move it forward. As long as someone takes care of the business part of it, I'm good.

Yeah, for sure. So I do want to talk about touch a little bit on Hent heavy, what exactly it is and then how do people get a hold of it? Like how do, how do people incorporate it into their practice?

Right. So great, great question. So just as a kind of a 30,000 foot view, let's just take an example of a two year old kid falls in a pool, is pulled out by the parents, child's on cardiac arrest. They call 911, 911 sends over the paramedics. That child needs a number of things, including we have to breathe for them, we have to do cpr. We have to either place an IV or put a needle into the bone called an IO and we have to give medication through that, through that called epinephrine. And we have to shock the patient depending on the situation. There's a lot of things happening all at one time. Like I mentioned earlier, every EMS system has their own 40 medications that they can pick and choose from. It's not a standard. When they buy that medication from the vendor, it can come as one or another concentration. As you know, like midazolam as an example, comes as 1 in 1 or 5 in 1. Then the medical director creates that protocol to say, but this kid who's having, let's say, a seizure. The dose I want you to give is 0.2 milligrams per kilogram intranasally IV. We're going to give it 0.1 milligrams. There's all these different iterations. You know, there's. So there's an old adage saying, you see one EMS system, you've seen one EMS system. And that, and that holds true for all the medications and the protocols. So what we did was we said, let us see your protocol. Tell us exactly what medications you carry. And then what our software does is we have a big back end piece that nobody sees. It ingests all of that information and it spits out on an age by age basis, if you're 1 years old or 5 years or 7 year old, and you're a paramedic and you open up our application, you hit five year old and all the medications that you need specifically for cardiac arrest or seizure or anaphylaxis, they're right there in front of you, already calculated. You tap on the button, epinephrine and you know, there's the dose. And all that's going to be sent to your electronic health record seamlessly at the very end with one push of the button. So we have all these integrations with all the, you know, the electronic health records of EMS. I think we're up to nine or 10 integrations now. So it allows cognitive offloading. And alongside of that we have an entire educational course. As you know, there's pals. PALS course. We've created our own course that every two years they get recertified and they have to recertify in some course. And our courses is a course that's at the same level of PALS as far as certification. And during that course, they learn about pediatric resuscitation, they learn about drug dosing, and they learn how to use their application. We've also integrated protocols, we've also integrated checklists. If you read the book by Atul Gawan, checklist manifesto, checklists are great, except that no one's been able to bring them to the point of care. We've done that now with the application. If you're doing cpr, our application, you press start cpr, it gives you five timers that are audio and visual cues. So you'll hear a metronome for the number of compressions to make every time you ventilate. Someone says on the app, ventilate, ventilate. When to charge the monitor, when to check for the two minute rhythm, when to give the next dose of epinephrine. All that's being done inside of the app in real time right when you're there at the side of the pool. And so that's the kind of thing that hen Tebi does. And it's, it's basically, it's a, it's a SaaS model. We don't sell to individuals. We only sell to, you know, organizations, hospitals mainly. Our biggest customer.

Municipal EMS systems. So think if you live in San Antonio or you live in Denver, you know, we have, and now we have four states that have adopted hemp heavy for every EMS system in their state, kind of wholesale. So basically every single agency was told by the state, we just got your hands heavy. And so that's been the last couple years has been tremendous. We have two more states coming on board now. But that's, that's effectively what we do, is that we help you not have that stress before you get to the scene. You have to stay on scene and treat the patient like you would have if it was an adult. And then we take all that documentation part of it, and with one push of a button, all that information goes right into your electronic health record, you know, as, as discrete data elements. So if you would look at that electronic health record that the paramedics submit at the end, you'll never know that the information came from hand heavy because it just, you know, through our API, it fits right where it's supposed to fit. So we saved them a lot of time, but more importantly, we're saving more lives and more kids are coming back to life. And there was a paper that was just published in January of 2021 from Denver showing that with the old system they had about a 50% medication error rate to only 50% correct. And with our system, they're at 89.4% correct medication doses. And that's, you know, that's been peer reviewed. There's been studies showing that the neurologic intact survival, which is normally about 5% in one county in Florida that actually published their paper, it went to 23%. So if you think, if you think of that, right, that's. They're quadrupling the number of children that are neurologically normal playing soccer in one county in Florida. And now anecdotally, I can tell you that we get calls from all over the country every week, and I've written hundreds of letters. We have this process where you, you send us, you fill in a little form about the save that you had, and then I write a personal letter and we send over challenge coins for everyone in the crew. So every Friday, I sit and I have the box full of challenge coin letters to write so I could hear and I can just kind of feel like I'm there at the scene when they're saving these people's lives is just an incredible thing to be a part of.

That's amazing. Hopefully, hopefully those letters get more and more out of hand because, I mean, that's amazing to hear. And, you know, that's the thing, like, you know, the fact that these people are taking time to write to you shows the impact that it's actually making. You know, these people are really busy. I mean, we barely have time to eat lunch, to be honest with you. But, like, they're taking time to reach out to you for an app that you created based on your own personal experiences of being uneasy in the situation. That's, that speaks volumes to what you, what you've created, honestly.

Well, I, I, I appreciate that before I, I jumped on with you, was on a call with, you know, we have 3,000 instructors across the country and had a big phone call with them. And what, what I tell them is that we don't want any of the credit. I mean, we, we sit here, we, we, we, we soak in the joy right when they have it saved. But we just tell them we are the vehicle. But they, they do the hard work and we want to honor them and we want to. But, you know, I can tell you from the seat that I sit in and the journey that I've been through, you know, and you saw earlier that, you know, just, just by hearing of the save and knowing that a child, a child is back to life neurologically Normal. I still get so emotional about it because, you know, I was in that situation where I didn't pull through for that family, right? And, and now to be in a situation where people that I don't even know who they are email me and call me and send me a note on Twitter, that is, you know, what keeps us going here at the company every single day.

So that's amazing for those listening. That's literally mission and vision and passion kind of coming together. And that's great to hear. I love, I love it when those three things align. And it, you can, you can hear it in your voice, you can hear it in people that it does align. One more thing about Hen Heavy. How do people get a hold of you guys?

The best way is LinkedIn. For me, you can go to the website, which is hen.com but I'm, I'm on Twitter and on LinkedIn, you know, we have all, we also have the Facebook pages. I, I, you know, have YouTube. We put a lot of content out. So just one more, one more kind of interesting learning along the way in the healthcare sphere is that nobody wants to hear, like, I rarely do this type of thing here because nobody wants to hear from the physician who created something that's a for profit anything. So what we do is I, I don't, I don't speak to, you know, any of the prospects. I don't talk numbers because it turns out they don't want to talk to me. And so what I, what I've done since we started the company is we just put out content and content. If you go to YouTube channel and you see me on a video, I don't talk about the product. I don't say, you go buy my product on LinkedIn. I never do that either. On Facebook, I put out, I read three journal articles a week and I summarize them, not about my product. And it's because at the end of the day, whether they use our product or not, I want them to be better at what they do. And ultimately, over the years, people now see us as if you're doing pediatric emergency care, especially if it's out of hospital. Those are the people you want to trust. And so I think that I didn't realize why I was so shy about talking about the company. But I give talks around the country today and never talk about the company. I talk about the problem, I talk about how to be better at what you do. And that served me very, very well. And I would recommend that to anyone else in healthcare. It turns out that the lay public doesn't want to hear from the person who created something, because their expectation is that if it's that good and you're a doctor, you should just give it away for free. Not recognizing that in order to make something valuable to save lives, then there has to be some kind of engine to actually make the company grow. So that was hard for me to get over, I can tell you that. But now that I, I have the ability to look back and see, I can understand why people feel that way. But it's very clear to me now that you have to, you have to make money, the company has to make money for your vision to come true, period.

100. I mean, if you want to scale something, you need money where unless you're like Google, Facebook, whatever, you know, they're, they make their money in other nefarious ways, you know. But I completely agree with you. There's a shift that I think. I don't know why in medicine you're not allowed to make money. Everyone's making money outside of the people actually trying to save people, right? Like, I, I, I, we can, we can have a whole another podcast just about that mindset. But, you know, I want to end this conversation with what advice would you give your. What, what advice would you have given yourself, you know, kind of back when you were, you know, doing your fellowships or just in med school, about all the stuff that, you know now?

What advice? You know, I, unfortunately, I still walk around with a chip on my shoulder today. I still see myself as the underdog. And part of that drives me, I have to admit. You know, I love being the underdog.

They've also told me that I'm the kind of guy who walks to the beat of my own drum. So I kind of, it's not that I'm stubborn. It's just that what I've learned about myself is that when, when every part of me is saying, you should do it, it's the right thing to do. It turns out that my, my gut instinct was, was correct, right? So I become much better in my, my older age. I'm understanding myself and understanding that when I, when I really feel strongly about something, I tend to follow that thing irrespective of what people are saying around me. So, you know, I wish I would have learned that lesson a little earlier, because in the early days, when someone that you really trust, who's a, let's say, a legend in the field, in the field that you're trying to become good in, and they tell you that Your idea is not any good. Well, that sets you back, right? I've learned now that. That I never should have listened to those people. And I'm not good at a lot of things. Okay, I'm not good at a lot of things. I'm good at a few things. And one of the things that I'm good at is when I know something is right and I'm going in that direction. And I'm a thinker. Like, I don't. I don't make any quick decisions, but, like, you know, I sometimes take time to make my decisions. But I realized that once I. I see something and I realize I'm really going down that path, I look at my history, and I've been right on those every time. So I now have learned to understand my brain, my heart, and how it's connected and trying to get too emotional about things. And then the other advice I give is that stay out of the business lane if you suck at it. And I suck at it. I'm not driven by money. You know, we grew up poor and had a great childhood. And, you know, I'm. I would say that take the business side and give it to someone that you trust, someone that's not going to screw you over, someone who's got the same mission as you do. And again, going back to the question you asked, I'm not sure how you do that. It's hard to do. But I would say stay in your lane. Do what you're good at, and surround yourself with wicked, smart people who are really good at what they do. That's kind of the best advice that I. That I wish I would have known many years ago.

Yeah, that's amazing. Both those points are amazing, and I don't have much to add, but, Peter, this was amazing. I, you know, talking to you has, you know, always gets me charged up. Stuff that you're doing, keep doing it. I know you won't say to buy your product, but I will tell people should buy his product. You know, if you were. If you got lost in any of this conversation, us talking about codes and all the things we have to do, that is exactly the reason why you need to buy a product like the one that they're making. And I think that in itself is the. Is why people should be paying attention.

Thank you. I appreciate that. And thank you for what you do. And I was telling you earlier off camera that ever since we spoke and I started listening to all your podcasts and I follow the people that you interviewed, my feed has become full of like these health tech business gurus like Preston Alexander, who like I wake up on Sunday morning like, where's his email?

Thank you for what you do. Kind of, you know, we've been hiding away. At least I can say personally, you know, I don't go to the conferences, I don't take emails from people who want to buy our company. I just, you know, but I love, I love at least feeling like I'm part of a community. And you brought that to me because I never, never had that before, kind of. It feels lonely when you do what you do. But to other people out there like you, who are bringing people together and make me feel like I can at least know some people from afar, it's been great. So thank you.

Well, thank you so much. That honestly means a lot and that's my goal. So I'm glad. I'm working towards that. But Peter, thank you again for your time and your generosity and keep, keep kicking but out there, man. I really love what you guys are doing and you know, hopefully we can talk, talk again in a couple years when everyone is switched over to your system.

I appreciate that. Thanks and hope to see you in real life one day soon.

Most definitely. Bye.

Take care.

Thanks for listening to another episode of Digital Thoughts with Zayn Syed. This episode is brought to you by stratapt. Strada PT is a single EMR platform and revenue cycle management service for physical, occupational and speech therapy practices that helps you achieve a 99.99% reimbursement rate. If you'd like to learn more about Strada PT and see how our EMR and RCM works, head over to stratapt.com to book a demo.